scholarly journals Assessment of the Functional Status of Patients with Ischaemic Stroke Receiving Thrombolytic Treatment

2020 ◽  
Vol 9 (1) ◽  
pp. 12-19
Author(s):  
Kazimiera Hebel ◽  
◽  
Przemysław Kowiański ◽  
Katarzyna Rogoza ◽  
◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Functional Status ◽  
Intravenous Thrombolysis ◽  
Cerebral Haemorrhage ◽  
National Institutes Of Health ◽  
Cerebral Stroke ◽  
Thrombolytic Treatment ◽  
Total Study Population ◽  
Study Objective ◽  
Haemorrhagic Transformation

Introduction. Intravenous thrombolysis is a gold standard in the treatment of acute ischaemic stroke. It causes reperfusion in the region of ischaemia and as a result it has a positive effect on functional outcomes of patients. The sooner this treatment is introduced the higher efficacy can be expected. Aim. The study objective was to assess the functional status of patients with ischaemic stroke, undergoing thrombolytic treatment and the incidence of thrombolysis complications. Material and Methods. Retrospective studies were conducted on a group of 109 patients hospitalised due to ischaemic cerebral stroke and qualified for thrombolytic treatment. The functional status was assessed with the use of the modified Rankin Scale and National Institutes of Health Stroke Scales on admission and discharge day. The study group included 55 males and 54 females (respectively: 50.5% and 49.5% of the total study population). The subject age was between 32 and 96 years, with the mean age of 69.8. Results. The average time between the onset of symptoms and initiation of thrombolytic treatment was 182 minutes. The National Institutes of Health Stroke Scale at the moment of qualification for treatment was 10.11 points, and the Rankin Scale was 2.88 points. On the day of discharge, the values were 5.81 and 2.05, respectively. A statistically significant (p < 0.0001) improvement in the functional status was observed in the group of patients who had no intra cerebral haemorrhage after thrombolysis. The most common complication of thrombolytic treatment was haemorrhagic transformation of the ischaemic stroke focus — 27 cases (24.77%). Death occurred in 9 subjects (8.26% of total), including 6 cases in males (10.91% of males) and was related to haemorrhagic transformation of the ischaemic stroke focus (p = 0.000). Conclusions. The implemented treatment of stroke resulted in improvement of the functional status. The most frequent complication was haemorrhagic conversion of stroke. (JNNN 2020;9(1):12–19) Key Words: stroke, thrombolysis, functional status

scholarly journals Treating ischaemic stroke with intravenous tPA beyond 4.5 hours under the guidance of a MRI DWI/T2WI mismatch was safe and effective

2019 ◽  
Vol 4 (1) ◽  
pp. 8-13 ◽  
Author(s):  
Qing-ke Bai ◽  
Zhen-guo Zhao ◽  
Lian-jun Lu ◽  
Jian Shen ◽  
Jian-ying Zhang ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Contrast Material ◽  
Final Analysis ◽  
National Institutes Of Health ◽  
Haemorrhagic Transformation ◽  
Intravenous Tissue Plasminogen Activator ◽  
Hyperintense Signal ◽  
Rapid Sequence ◽  
Tissue Plasminogen ◽  
Sequence Study

PurposeClinical trials have provided evidence that treating patients with acute ischaemic stroke (AIS) beyond 4.5 hours was feasible. Among them using MRI diffusion-weighted imaging/fluid attenuation inversion response (DWI/FLAIR) mismatch to guide intravenous tissue plasminogen activator (tPA) was successful. Our study explored the outcome and safety of using DWI/T2-weighted imaging (T2WI) mismatch to guide intravenous tPA therapy for patients with AIS between 4.5 hours and 12 hours of onset.MethodThis was a retrospective study. Records of 1462 AIS patients with the time of onset of <12 hours were reviewed. Those had MRI rapid sequence study and had hyperintense signal on DWI but normal T2WI and received intravenous tPA up to 12 hours of onset were included in the analysis. Their demographics, risk factors, post-tPA complications, National Institutes of Health Stroke Scale (NIHSS) scores and outcome were recorded and analyse. χ2 was used to compare the intergroup variables. SAS was used to perform statistical calculation. A p<0.05 was considered statistically significant.ResultsOf 1462 identified, 601 (41%) patients were entered into the final analysis. Among them, 327 (54%) had intravenous tPA within 4.5 hours of onset and 274 (46%) were treated between 4.5–12 hours. After intravenous tPA, 426 cases (71%) had >4 pints of improvement on NIHSS score within 24 hours. Postintravenous tPA, 32 (5.32%) cases had haemorrhagic transformation. 26 (4.33%) were asymptomatic ICH and 4 (0.67%) died. At 90 days, 523 (87%) achieved a modified Rankin scale of 0–2.ConclusionUsing MRI DWI/T2WI mismatch to identify patients with AIS for intravenous tPA between 4.5 hours and 12 hours was safe and effective. The outcome was similar to those used DWI/PWI or DWI/FLAIR mismatch as the screening tool. However, obtaining DWI/T2WI was faster and avoided the need of contrast material.

scholarly journals Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous thrombolysis

Medicine ◽  
2020 ◽  
Vol 99 (7) ◽  
pp. e18995 ◽  
Author(s):  
Lihong Wen ◽  
Song Zhang ◽  
Kunzhen Wan ◽  
Hong Zhang ◽  
Xiaoyun Zhang
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Chinese Patients ◽  
Haemorrhagic Transformation

scholarly journals Risk factors of haemorrhagic transformation for acute ischaemic stroke in Chinese patients receiving intravenous recombinant tissue plasminogen activator: a systematic review and meta-analysis

2018 ◽  
Vol 3 (4) ◽  
pp. 203-208 ◽  
Author(s):  
Yijia Guo ◽  
Yaqiong Yang ◽  
Muke Zhou ◽  
Li He
Keyword(s):  
Risk Factors ◽  
Ischaemic Stroke ◽  
Plasminogen Activator ◽  
Acute Ischaemic Stroke ◽  
Meta Analysis ◽  
Intravenous Thrombolysis ◽  
Recombinant Tissue Plasminogen Activator ◽  
Chinese Patients ◽  
Haemorrhagic Transformation ◽  
Tissue Plasminogen

ObjectiveTo identify risk factors for haemorrhagic transformation in Chinese patients with acute ischaemic stroke treated with recombinant tissue plasminogen activator.MethodsWe searched electronic databases including PubMed, EMBASE, CNKI and WanFang Data for studies reporting risk factors of haemorrhagic transformation after intravenous thrombolysis. Pooled OR, weighted mean difference (WMD) and 95% CI were estimated. Meta-analysis was performed by using Stata V.14.0 software.ResultsA total of 14 studies were included. The results indicated that older age (WMD=3.46, 95% CI 2.26 to 4.66, I2=47), atrial fibrillation (OR 2.66, 95% CI 1.85 to 3.81, I2=28), previous stroke (OR 1.68, 95% CI 1.08 to 2.60, I2=14), previous antiplatelet treatment (OR 1.67, 95% CI 1.17 to 2.38, I2=0), higher National Institute of Health stroke scale scores (OR 1.10, 95% CI 1. 05 to 1.15, I2=36), systolic (WMD=4.75, 95% CI 2.50 to 7.00, I2=42) or diastolic (WMD=2.67, 95% CI 1.08 to 4.26, I2=35) pressure, and serum glucose level (WMD=1.44, 95% CI 0.62 to 2.26, I2=66) were associated with increased risk of post-thrombolysis haemorrhagic transformation.ConclusionThe current meta-analysis identified eight risk factors for post-thrombolysis haemorrhagic transformation in Chinese patients with acute ischaemic stroke. Given the risk of bias, these results should be explained with caution and do not justify withholding intravenous thrombolysis.

Carotid endarterectomy following thrombolysis for acute ischaemic stroke

VASA ◽  
2017 ◽  
Vol 46 (2) ◽  
pp. 116-120 ◽  
Author(s):  
Naz Ahmed ◽  
Damian Kelleher ◽  
Manmohan Madan ◽  
Sarita Sochart ◽  
George A. Antoniou
Keyword(s):  
Ischaemic Stroke ◽  
Carotid Endarterectomy ◽  
Acute Ischaemic Stroke ◽  
Intravenous Thrombolysis ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Wound Complications ◽  
Cardiac Complications ◽  
High Dependency ◽  
Low Incidence

Abstract. Background: Insufficient evidence exists to support the safety of carotid endarterectomy (CEA) following intravenous thrombolysis (IVT) for acute ischaemic stroke. Our study aimed to report a single-centre experience of patients treated over a five-year period. Patients and methods: Departmental computerised databases were interrogated to identify patients who suffered an ischaemic stroke and subsequently underwent thrombolysis followed by CEA. Mortality and stroke within 30 days of surgery were defined as the primary outcome end points. Results: Over a five-year period, 177 out of a total of 679 carotid endarterectomies (26 %) were performed in patients presenting with acute ischaemic stroke. Twenty-five patients (14 %) received IVT prior to CEA in the form of alteplase. Sixty percent of patients were male with a mean age of 68 years. Sixteen patients (64 %) underwent CEA within 14 days of IVT and the median interval between thrombolysis and CEA was 7.5 days (range, 3–50 days). One female patient died of a further intraoperative stroke within 30 days of surgery, yielding a mortality rate of 4 %. Two patients (8 %) suffered from cardiac complications postoperatively resulting in a short high dependency unit stay. Another two patients (8 %) developed local wound complications, which were managed conservatively without the need for re-operation. The median hospital length of stay was 4.5 days (range, 1–33 days). Conclusions: Our experience indicates that CEA post-thrombolysis has a low incidence of mortality. Further high quality evidence is required before CEA can be routinely recommended following IVT for acute ischaemic stroke.

scholarly journals Efficacy and safety of butylphthalide for patients who had acute ischaemic stroke receiving intravenous thrombolysis or endovascular treatment (BAST trial): study protocol for a randomised placebo-controlled trial

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e045559
Author(s):  
Xuelei Zhang ◽  
Anxin Wang ◽  
Jing Yu Zhang ◽  
Baixue Jia ◽  
Xiaochuan Huo ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Endovascular Treatment ◽  
Functional Outcome ◽  
Acute Ischaemic Stroke ◽  
Controlled Trial ◽  
Intravenous Thrombolysis ◽  
Serious Adverse Events ◽  
Double Blind ◽  
Ischaemic Injury ◽  
Study Results

IntroductionAs a neuroprotective medication, butylphthalide (NBP) may help protect against cerebral ischaemic injury. However, evidence on whether NBP influences the outcomes of patients who had acute ischaemic stroke who are receiving revascularisation treatment is limited. This study aims to evaluate whether additional NBP therapy can improve the functional outcome of patients who receive intravenous recombinant tissue plasminogen activator and/or endovascular treatment (EVT).Methods and analysisThe study will be a randomised, double-blind, placebo-controlled, multiple-centre, parallel group trial. The sample size is estimated at 1200 patients. Eligible patients will be randomised at a 1:1 ratio to receive either NBP or placebo daily for 90 days, which will include 14 days of injections and 76 days of capsules. The first use of NBP/placebo will be started within 6 hours of onset of ischaemic stroke. The primary outcome is the functional outcome as assessed by the 90-day modified Rankin Scale, adjusted for baseline scores on the National Institutes of Health Stroke Scale. The primary safety outcome is the percentage of serious adverse events during the 90 days of treatment. This trial will determine whether NBP medication benefits patients who had acute ischaemic stroke who receive intravenous thrombolysis or EVT.Ethics and disseminationThe protocol was written according to the general ethical guidelines of the Declaration of Helsinki and approved by the Institutional Review Board/Ethics Committee of Beijing Tiantan Hospital, Capital Medical University with approval number KY 2018-003-02. Ethics committees of all participating sites have approved the study . Results of the study will be published in peer-reviewed scientific journals and shared in scientific presentations.Trial registration numberNCT03539445.

Sign in / Sign up

Export Citation Format

Share Document